FHIR Provider Directory

Product Description

As part of The Centers for Medicare and Medicaid Services (“CMS”) Interoperability and Patient Access Rule, CareFirst is implementing Provider Directory as publicly available API. This will allow third-party application developers to access provider information for given plan. FHIR Provider Directory product enables member to see which providers are in-network for a given insurance plan.

These APIs follow the HL7 R4 FHIR specification, as well as the DaVinci PDEX Plan Net implementation guide.

This API returns data for given plan from below list of plans.

  • CHPMD  : CareFirst BlueCross BlueShield Community Health Plan Maryland (aka MD Medicaid).

  • CHPDC  : CareFirst BlueCross BlueShield Community Health Plan District of Columbia (aka DC Medicaid).

  • DSNP     : CareFirst BlueCross BlueShield Medicare Advantage Dual Prime (aka MD DSNP).

  • MAPD    : CareFirst BlueCross BlueShield Medicare Advantage.

  • EGWP   : Employer Group Waiver Plan.